Evidence Table: Pneumococcal Vaccine for Adults

Name
Title
EVIDENCE TABLE
CITATION
Author(s), Date, Title, Journal Information, DOI

Level of Evidence

PURPOSE / BACKGROUND
Purpose & Outcome Measures or Goals (Aims)

PARTICIPANTS / SETTING
Sample & Setting

METHODS / DESIGN
Study Design & Interventions

RESULTS / LIMITATIONS / RECOMMENDATIONS
Results, Strengths/Weaknesses, Limitations, & Recommendations

Cafiero-Fonseca, E. T., Stawasz, A., Johnson, S. T., Sato, R., & Bloom, D. E. (2017). The full benefits of adult pneumococcal vaccination: A systematic review. PLoS One, 12(10), e0186903. https://doi.org/10.1371/journal.pone.0186903.

I

Background
Pneumococcal vaccine for adults can be effectively used to minimize the burdens associated with pneumococcal diseases.
Purpose
The researchers conducted a study to explore the extent to which the existing literature identifies all the benefits of the pneumococcal vaccine. The second objective of the study was to identify the types of benefits recognized in the literature review.
Aims
Specifically, the paper aimed to identify the depth and breadth of the findings showing that adult pneumococcal vaccines are beneficial.

5,857 papers were identified with 150 of them included in the final review

Systematic review: Studies published between January 2010 and 2016 examining the benefits of pneumococcal vaccines were included in the review.

Results
Majority of studies examining the benefits of the pneumococcal vaccine capture the health advantages associated with the pneumococcal vaccine and savings but do not consider other essential benefits such as productivity due to the vaccine's use. The narrow benefits captured in the study were cost savings, with the broad benefits captured in the studies being outcome-related gains in productivity and care-related productivity gains
Strengths
The review explores all the studies published on the benefits of pneumococcal vaccines.
Limitations
First, the study included only English-published studies. Second, the review did not use a standard bias assessment tool for the included studies. Third, the societal perspective as included in the studies was not defined explicitly.
Recommendation
The full benefits of pneumococcal are undervalued.

Fathima, M., Bawa, Z., Mitchell, B., Foster, J., Armour, C., & Saini, B. (2021). COPD management in community pharmacies results in improved inhaler use, immunization rate, COPD action plan ownership, COPD knowledge, and reductions in exacerbation rates. International Journal of Chronic Obstructive Pulmonary Disease, 16, 519. https://doi.org/10.2147/COPD.S288792

IV

Background
COPD negatively affects the quality of a patient’s life but early interventions can reduce the exacerbation of COPD, lead to reduced care costs, and enhance the quality of life.
Purpose
The objective of the current study was to investigate the effectiveness of a pharmacy care model that helped patient improve their adherence to medication, inhaler technique, and uptake of prevention activities.
Outcome Measures
The primary outcome measure was a change in the number of correct inhaler techniques accomplished by the patients. Secondary measures included medication adherence, quality of life, breathlessness, current smoking status, COPD knowledge, vaccination status, exacerbation frequency, and PR clinic attendance.

Participants
40 potential participants consented from 145 potential participants. 37 attended the first visit, 31 attended the second visit, and 27 attended visit 3.
Settings
9 community pharmacies in Sydney, Australia.

Study Design
Pre-post pilot study
Intervention
The participants were subjected to a comprehensive COPD management model.

Results
The intervention delivered by the pharmacist contributed to significant improvement in the patient inhaler technique, knowledge about COPD, exacerbation of COPD, and pneumonia immunization rate.
Strengths
The details of the pilot study are adequately provided making it easy to replicate the study.
Limitations
The study had a small number of patients without a control group. The effect of seasonal changes on COPD exacerbation was not taken into account during the pilot study.
Recommendations
A new model of care that leverage all point-of-care access can improve the uptake of the vaccine.

Ho, H. J., Tan, Y.-R., Cook, A. R., Koh, G., Tham, T. Y., Anwar, E., Hui Chiang, G. S., Lwin, M. O., & Chen, M. I. (2019). Increasing Influenza and Pneumococcal Vaccination Uptake in Seniors Using Point-of-Care Informational Interventions in Primary Care in Singapore: A Pragmatic, Cluster-Randomized Crossover Trial. American Journal of Public Health, 109(12), 1776–1783. https://doi.org/10.2105/ajph.2019.305328

II

Background
Despite the reported efficacy of pneumococcal vaccination in reducing the risk of influenza virus, the uptake of vaccinations among the elderly remains dismal.
Purpose
The purpose of the current study was to examine the effectiveness of an intervention at the GP point of care that utilizes informational material to improve influenza and pneumococcal uptake in the elderly.
Outcome Measures
The primary outcome was the variation in influenza and pneumococcal vaccination uptake rates and the secondary outcome was the identification of factors at individual and cluster levels.

Participants
4378 participants in the intervention period and 4459 participants in the control period
Settings
Private GP clinics in Singapore

Study Design
A pragmatic, cluster-randomized crossover trial
Intervention
The intervention material included information that encouraged patients to take up vaccinations by detailing the benefits.

Results
The overall uptake of vaccines was higher during the intervention phase than during the control phase. Multivariable analysis indicated that patients who visited during the intervention phase were more likely to receive vaccinations than those who visited during the control period.
Strengths
The researcher relied on data from the clinical electronic medical records to complete the study. Participants were diverse and the interventions were cost-effective and brief.
Limitations
The researchers did not determine the baseline vaccination rate of the participating clinics. Further, the researchers could not control external factors that had a confounding effect on vaccination uptake. The compliance level during the intervention period was not measured.
Recommendations
The rate of vaccine uptake among the elderly can be improved with the use of point-of-care informational programs.

Jacobson Vann, J. C., Jacobson, R. M., Coyne-Beasley, T., Asafu-Adjei, J. K., & Szilagyi, P. G. (2018). Patient reminder and recall interventions to improve immunization rates. Cochrane Database of Systematic Reviews, 2018(1). https://doi.org/10.1002/14651858.cd003941.pub3

I

Background
The use of patient reminders and recall systems has emerged as one of the frequently used interventions to raise the rates of vaccination in the population.
Purpose
The purpose of the study was to compare the various approaches to patient reminders and recall in enhancing vaccination uptake.
Outcome Measures
The primary outcome measure was vaccination.

75 studies were included in the review (18 qualitative synthesis and 57 quantitative studies)

Systematic review

Results
The use of patient reminder and recall improves vaccine uptake (risk ratio (RR) of 1.28, 95% confidence interval (CI) 1.23 to 1.35; risk difference of 8%). There was moderate evidence that the use of phone call reminders improves vaccination uptake, with autodialler, text messages, and postcards reporting high certainty evidence.
Strengths